关键词: 血压变异性; 卒中; 类型; 大动脉粥样硬化性

Abstract:

Objective To analyze the characteristics of blood pressure variability(BPV) in acute stroke patients, and to explore the association between BPV and different types of stroke. Methods A prospective study was conducted among 306 consecutively admitted patients of acute stroke from the department of Neurology in Beijing Tiantan Hospital during the period from March 2012 to December 2012. Patients were divided into cerebral hemorrhage group and ischemic stroke (IS) group. The latter was further divided into large artery atherosclerosis(LAA) subgroup and non- LAA subgroup according to China Ischemic Stroke Subclassification(CISS). Twenty four hour ambulatory blood pressure monitoring(ABPM) was tested in all the patients, and the index were recorded, including systolic blood pressure(SBP) (24-hour, day-time and night-time), diastolic blood pressure(DBP) (24-hour, day-time and night-time), mean blood pressure(MBP) (24-hour, daytime and night-time), pulse pressure(PP) (24-hour, day-time and night-time), heart rate(HR) (24-hour,day-time and night-time), and modified Rankin Scale(mRS) score. mRS score was recorded when patients discharged or on the 21st day after their onset. One-way analysis of variance, chi-quare test and logistic regression were applied to evaluate the differences of the indicators between different groups, which included general information, past medical history, neurological function, mRS score, MBP, and indicators of BPV(the standard deviation[SD] and the coefficient of variation[CV] of SBP, DBP, MBP and PP). Results A total of 306 cases of acute stroke patients were investigated, including 123 cerebral hemorrhage cases and 183 cerebral infarction(CI) cases. (1) There was no significant increase in the value of 24 h-MBP in acute stroke patients. The values of 24 h-DBP, d-DBP(day-time DBP), n-DBP(night-time DBP) , 24 h-HR, d-HR, n-HR in cerebral hemorrhage group were significantly higher than those in CI group. Conversely, the value of 24 h-PP, d-PP, n-PP in CI group were significantly higher than those incerebral hemorrhage group. (2) BPV was significantly different in cerebral hemorrhage group and ischemic stroke group. P value of the SD of SBP and MBP, the CV of SBP, DBP and MBP were all below 0.05, which indicated that cerebral infarction patients hadhigher BPV. However, there were no significant differences of BPV between the two subgroups, LAA group and non-LAA group. (3) Acute stroke patients hada higher proportion of non-dipper blood pressure, but there were no statistically significant differences between different types of stroke, as well as in different subgroups. Conclusion (1) In this study, we found that the average DBP and the average HR in cerebral hemorrhage group were higher than those in CI group. Average PP in CI group was higher than that in cerebral hemorrhage group. There was no significant difference of MBP between the two subgroups of CI. (2) BPV was significantly different between the cerebral hemorrhage group and the CI group. The latter had greater BPV. However, there was no significant differences of BPV between the subtypes of cerebral infarction. (3) Patients with acute stroke has a higher proportion of non-dipper blood pressure, but when it came to different types of strokeand different subtypes of CI, the differences were not significant.

Key words: Blood pressure variability; Stroke; Type; Large artery atherosclerosis